/ Bridge Inspection
Procedures Review
GENERAL INFORMATION
In accordance with Structural Services Manual Section 3.9.3.2, a Program Manager must accompany each Team Leader functioning within the Program Manager’s area of responsibility to observe the Team Leader’s performance of NBIS inspections on at least three (3) structures over the course of a 30 day period. Program Managers should choose inspections of different structure types and include a Fracture Critical Member Inspection, whenever possible, for the purpose of monitoring the Team Leader’s performance in a variety of circumstances. The Program Manager should increase the number of bridge inspections monitored or reduce the period of time between inspection-monitoring as needed to address concerns with the Team Leader’s performance. If the Program Manager determines that a Team Leader is not capable of functioning at a satisfactory level to ensure acceptable inspection procedures and ratings, the Team Leader shall no longer be utilized. A disqualified Team Leader shall be reported to the State Program Manager for final resolution.
PROGRAM MANAGER INFORMATION
Inspection procedure review conducted by:
Program Manager:
Inspector ID:
Phone No: / Email Address:
REVIEWED TEAM LEADER
Team Leader:
Inspector ID::
Phone No: / Email Address:
Date of Safety Inspection of In-Service Bridges Class:
Date of Most Recent Inspection Refresher Class:
Team Leader Approval Date:
TEAM MEMBER(S) ASSISTING
Name:
Title:
Phone No: / Email Address:
BRIDGE INSPECTION INFORMATION Bridge #1
SN: / - / Location:
Start Date & Time of Inspection: / End Time:
Temperature: / ° F / Weather Conditions:
Main Span Superstructure Type:
Routine Inspection / In-Depth Inspection / Element Inspection
Fracture Critical Inspection / Underwater Inspection
INSPECTION CREW SAFETY:
Procedures used provided adequate safety for inspection personnel: / Yes / No
Procedures used addressed safety of vehicles adjacent to roadways: / Yes / No
ACCESS TO STRUCTURE:
If present, Fracture Critical members were inspected at arms-length: / Yes / No / n/a
If Substructure Units were in shallow water, Units were probed/waded: / Yes / No / n/a
Adequate and appropriate equipment used during the inspection: / Yes / No
CONDITION RATING ASSESSMENT:
Condition Ratings assigned to the following Items were acceptable:
(“n/a” indicates “Not Applicable”)
Item 58, “Deck” / Yes / No / n/a
Item 59, “Superstructure” / Yes / No / n/a
Item 60, “Substructure” / Yes / No / n/a
Item 61, “Channel Condition” / Yes / No / n/a
Item 62, “Culvert” / Yes / No / n/a
Item 71, “Waterway Adequacy” / Yes / No / n/a
Item 72, “Approach Roadway Alignment” / Yes / No / n/a
Item 111, “Pier Navigation Protection” / Yes / No / n/a
ELEMENT RATING ASSESSMENT (if applicable):
Element Ratings assigned to the following were acceptable:
(“n/a” indicates “Not Applicable”)
Elements were properly coded / Yes / No / n/a
Element Total Quantities were reviewed / Yes / No / n/a
Element Condition States were acceptable / Yes / No / n/a
INVENTORY INFORMATION EVALUATION:
Master Structure Report (S-107) or Inspector’s Inventory Report (S-114) was reviewed:
Item 43A/B, “Main Structure Material/Type”, was correct / Yes / No / n/a
Item 49, “Structure Length”, was correct / Yes / No / n/a
Item 52, “Total Deck Width”, was correct / Yes / No / n/a
Item 34/34A, “Skew Direction / Angle”, was correct / Yes / No / n/a
BRIDGE INSPECTION INFORMATION Bridge #1
If NO for any of the above items, explain:
FINDINGS AND RECOMMENDATIONS:
The procedures used by the Team Leader for the inspection were found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address inspection procedures.
The performance of the Team Leader was found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address Team Leader’s performance.
Based on the results of the Bridge Inspection Procedures Review, the Team Leader
may continue to discharge the duties of a Team Leader.
will cease to discharge the duties of a Team Leader until corrective actions are addressed. Please contact the State Program Manager.
Signature: / Date:
(Program Manager)
BRIDGE INSPECTION INFORMATION Bridge #2
SN: / - / Location:
Start Date & Time of Inspection: / End Time:
Temperature: / ° F / Weather Conditions:
Main Span Superstructure Type:
Routine Inspection / In-Depth Inspection / Element Inspection
Fracture Critical Inspection / Underwater Inspection
INSPECTION CREW SAFETY:
Procedures used provided adequate safety for inspection personnel: / Yes / No
Procedures used addressed safety of vehicles adjacent to roadways: / Yes / No
ACCESS TO STRUCTURE:
If present, Fracture Critical members were inspected at arms-length: / Yes / No / n/a
If Substructure Units were in shallow water, Units were probed/waded: / Yes / No / n/a
Adequate and appropriate equipment used during the inspection: / Yes / No
CONDITION RATING ASSESSMENT:
Condition Ratings assigned to the following Items were acceptable:
(“n/a” indicates “Not Applicable”)
Item 58, “Deck” / Yes / No / n/a
Item 59, “Superstructure” / Yes / No / n/a
Item 60, “Substructure” / Yes / No / n/a
Item 61, “Channel Condition” / Yes / No / n/a
Item 62, “Culvert” / Yes / No / n/a
Item 71, “Waterway Adequacy” / Yes / No / n/a
Item 72, “Approach Roadway Alignment” / Yes / No / n/a
Item 111, “Pier Navigation Protection” / Yes / No / n/a
ELEMENT RATING ASSESSMENT (if applicable):
Element Ratings assigned to the following were acceptable:
(“n/a” indicates “Not Applicable”)
Elements were properly coded / Yes / No / n/a
Element Total Quantities were reviewed / Yes / No / n/a
Element Condition States were acceptable / Yes / No / n/a
INVENTORY INFORMATION EVALUATION:
Master Structure Report (S-107) or Inspector’s Inventory Report (S-114) was reviewed:
Item 43A/B, “Main Structure Material/Type”, was correct / Yes / No / n/a
Item 49, “Structure Length”, was correct / Yes / No / n/a
Item 52, “Total Deck Width”, was correct / Yes / No / n/a
Item 34/34A, “Skew Direction / Angle”, was correct / Yes / No / n/a
BRIDGE INSPECTION INFORMATION Bridge #2
If NO for any of the above items, explain:
FINDINGS AND RECOMMENDATIONS:
The procedures used by the Team Leader for the inspection were found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address inspection procedures.
The performance of the Team Leader was found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address Team Leader’s performance.
Based on the results of the Bridge Inspection Procedures Review, the Team Leader
may continue to discharge the duties of a Team Leader.
will cease to discharge the duties of a Team Leader until corrective actions are addressed. Please contact the State Program Manager.
Signature: / Date:
(Program Manager)
BRIDGE INSPECTION INFORMATION Bridge #3
SN: / - / Location:
Start Date & Time of Inspection: / End Time:
Temperature: / ° F / Weather Conditions:
Main Span Superstructure Type:
Routine Inspection / In-Depth Inspection / Element Inspection
Fracture Critical Inspection / Underwater Inspection
INSPECTION CREW SAFETY:
Procedures used provided adequate safety for inspection personnel: / Yes / No
Procedures used addressed safety of vehicles adjacent to roadways: / Yes / No
ACCESS TO STRUCTURE:
If present, Fracture Critical members were inspected at arms-length: / Yes / No / n/a
If Substructure Units were in shallow water, Units were probed/waded: / Yes / No / n/a
Adequate and appropriate equipment used during the inspection: / Yes / No
CONDITION RATING ASSESSMENT:
Condition Ratings assigned to the following Items were acceptable:
(“n/a” indicates “Not Applicable”)
Item 58, “Deck” / Yes / No / n/a
Item 59, “Superstructure” / Yes / No / n/a
Item 60, “Substructure” / Yes / No / n/a
Item 61, “Channel Condition” / Yes / No / n/a
Item 62, “Culvert” / Yes / No / n/a
Item 71, “Waterway Adequacy” / Yes / No / n/a
Item 72, “Approach Roadway Alignment” / Yes / No / n/a
Item 111, “Pier Navigation Protection” / Yes / No / n/a
ELEMENT RATING ASSESSMENT (if applicable):
Element Ratings assigned to the following were acceptable:
(“n/a” indicates “Not Applicable”)
Elements were properly coded / Yes / No / n/a
Element Total Quantities were reviewed / Yes / No / n/a
Element Condition States were acceptable / Yes / No / n/a
INVENTORY INFORMATION EVALUATION:
Master Structure Report (S-107) or Inspector’s Inventory Report (S-114) was reviewed:
Item 43A/B, “Main Structure Material/Type”, was correct / Yes / No / n/a
Item 49, “Structure Length”, was correct / Yes / No / n/a
Item 52, “Total Deck Width”, was correct / Yes / No / n/a
Item 34/34A, “Skew Direction / Angle”, was correct / Yes / No / n/a
BRIDGE INSPECTION INFORMATION Bridge #3
If NO for any of the above items, explain:
FINDINGS AND RECOMMENDATIONS:
The procedures used by the Team Leader for the inspection were found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address inspection procedures.
The performance of the Team Leader was found to be:
Satisfactory / In Need of Improvement / Unsatisfactory
If “In Need of Improvement” or “Unsatisfactory”, provide reasons and corrective actions to
be taken to address Team Leader’s performance.
Based on the results of the Bridge Inspection Procedures Review, the Team Leader
may continue to discharge the duties of a Team Leader.
will cease to discharge the duties of a Team Leader until corrective actions are addressed. Please contact the State Program Manager.
Signature: / Date:
(Program Manager)

Printed 1/26/2017 Page 7 of 7 BBS 2790 (Rev. 01/26/17)